Using EMDR with BIPOC Clients: Six Strategies for Children, Adolescents, and Adults

July is BIPOC Mental Health Month, a great time to center the BIPOC experience and encourage EMDR therapists to reflect on best strategies of care for BIPOC clients.

Using EMDR with BIPOC Clients: Six Strategies for Children, Adolescents, and Adults

Guest Blog Post by Dr. Jenay Garrett, LPC-S

Did you know that working with Black, Indigenous, and People of Color (BIPOC) clients using EMDR demands more than just clinical technique? Many BIPOC clients carry not just personal experiences, but collective, generational, racial, and historical experiences or traumas embedded in their lived experience or DNA (Comas-Díaz, 2016; Bryant-Davis & Ocampo, 2005). As clinicians, we must intentionally bring cultural humility and responsiveness into every phase of treatment—especially Phases 1 and 2. To do this, clinicians must acknowledge their clients’ realities, historical wounds, and identity-based stressors. Below are six key strategies that help clinicians increase trauma-informed, anti-racist, and anti-oppressive care.

1. Acknowledge the impact of racial and historical trauma

Many BIPOC clients have experienced compounded trauma from racism, intergenerational violence, colonization, and systemic injustice (Comas-Díaz, 2016). At times, these experiences go unnoticed or untreated, especially if the client is not yet fully aware of the impact of their experiences. These experiences contribute to emotional dysregulation, internalized oppression, and mistrust of systems – including mental health systems. For example, various BIPOC cultural groups have an unspoken rule about trusting individuals outside of their culture and outside of their home. As a result, clinicians must introduce the possibility of such experiences impacting their current mental state in order to help the client become aware of those wounds. If ignored, these trauma layers can become blocked processing points while desensitizing a memory.

While gathering client history and information during Phase 1, a clinician should explicitly assess for collective, historical, and cultural experiences. For example, a Hispanic adolescent experiencing school-based anxiety may also struggle to assimilate to the cultural norms of an environment where few individuals look like them—challenges that emerge from the intersections of their identity. These aren’t “by chance” experiences to minimize, they are potentially central to the client’s trauma and loss narrative. Acknowledging the impact of racial and historical trauma aids the clinician in creating a safe space for their client, without the client having to ask. Acknowledging the impact of a BIPOC client’s full experiences requires intentional cultural humility.

2. Maintain a posture of cultural humility and anti-racism

As clinicians we may ask ourselves “How do I address racial identity differences between myself and my client?” Cultural humility is a commitment to self-evaluation and attuning for power imbalances (Tervalon & Murray-García, 1998). Rather than ignoring or not acknowledging the differences, it is helpful to lean in and explore the difference. Clients often feel more empowered when the clinician acknowledges, rather than avoids, topics of race and identity (Lipscomb & Ashley, 2021). Some examples of culturally humble practices include researching information regarding the intersections of the client’s identity, inviting the client to tell their story, and using culture-based resources and references. Some examples include using images with diverse individuals, incorporating language and references familiar to the client based on their identity, and using culturally based questionnaires and assessments.

An important element of EMDR phases 1 and 2 is ensuring that your client feels heard and valued during the process. It is equally important to explore how race, privilege, and bias show up in the therapy session. We must model anti-racist practice by examining our own blind spots, such as potential stereotypes we have believed and personal biases. Additionally, it is important to engage in continued dialogue, especially when there are differences in the racial, ethnic, or cultural backgrounds between a client and clinician.

3. Use cultural and identity-based questionnaires

Collecting cultural and identity information is key to a client’s history, which makes the data collected in phase 1 essential. To prepare for accurate target selection and treatment planning, you must assess a client’s cultural background, racial and ethnic identity, language preferences, acculturation, and lived experiences from the lens of all their identity markers.

Integrating questions that highlight a client’s identity, race, and culture into your intake process is essential. This can be done in various ways to include embedding the questions in the intake forms and/or asking the client or their care giver(s) the questions during the initial sessions. Examples of these questions may include:

“Can you tell me about some of the important aspects of your identity?”
“Have you ever been treated differently because of your racial or ethnic background?”
“What community traditions or healing practices are meaningful to you?”

Clinicians should note that collecting this information can be triggering and may take several sessions as the client learns to trust you, as it is important for the clients to feel safe and supported when acknowledging these wounds. There are a host of formal cultural and identity-based questionnaires that provide targeted questions, however, a clinician can also ask such questions informally. These questions allow you to access deeper roots, attachment issues, and shape targets that honor their full experiences (Archer, 2020)

4. Validate client experiences to ensure they feel seen

Validation is essential to the therapeutic process and engagement in therapy. BIPOC clients are often silenced in various systems when they discuss experiences concerning identity-related harm (Williams et al., 2018). If we do not validate these experiences, we risk replicating systemic harm in our therapy session.

Some examples of validating statements include:

“I’m so glad you have chosen to share this with me.”
“That sounds like a lot to experience.”
“You did not deserve to be treated that way.”

For younger clients, validation can look like affirming their feelings about being “different,” leaning into what is important to them and incorporating that into your sessions. Additionally, helping your client recognize that the impact of oppression and systemic issues they are experiencing is likely generational and did not begin with them can deepen conceptualization and increase client’s awareness. An example of this would be validating their feelings while helping a client understand the root of the pressure they receive from their parents/guardians to work twice as hard to be “successful” as their white peers.

5. Learn ways to adapt your interventions to various groups of people

Flexibility is essential when working with BIPOC clients. Allowing clients to explore their experiences within a larger cultural or historical context opens the door for the intersections of their identity. When working with children and adolescents, traditional EMDR protocols may need to be modified to fit cultural norms. Additional elements to consider are your client’s developmental stage and expressive preferences. For children and adolescents, it’s often more effective to use creative and play-based interventions to help them process trauma while remaining in their window of tolerance. BIPOC youth may feel more emotionally safe and empowered when the clinician incorporates cultural narratives, storytelling, music, or community-based imagery that they can connect with.

Strategies for adaptation may include:

Using culturally centered resourcing such as family rituals, religious icons, or community figures (e.g., ancestors or spiritual leaders) to foster grounding and resilience (Mbazzi et al., 2021).
Using a sandtray to help younger clients symbolically represent people, systems, or places of cultural significance.
Encouraging a client to lean into the intersections of their identity when creating their Safe/Calm Place or Positive Cognition. For younger clients, it may also help to have them draw these out.
Using storytelling or narrative therapy techniques to explore intergenerational or race-based traumas.
Identifying creative alternatives to bilateral stimulation that incorporate parts of the client’s racial and ethnic identities. Examples may include using culturally meaningful items for tactile bilateral stimulation, drumming or tapping to culturally rhythmic beats, and incorporating body movements/cultural dances (Mbazzi et al., 2021).

6. Seek supervision and consultation

Consultation is a powerful tool, no matter the experience of the clinician. Culturally humble treatment involves an ongoing learning process. Attending training, joining BIPOC affinity groups, or consultation groups are essential. Clinicians must foster brave spaces where race, power, and cultural identity can be openly addressed. Normalize reflective questions like:

“What do you think about your race or ethnicity impacteding this situation?”
“Am I (clinician) making assumptions?”

Intentional reflection allows clinicians to identify their biases and blind spots.

Inviting discussion makes a deeper impact

EMDR is a powerful therapy that is rooted in transforming the functioning of clients. Practicing cultural humility helps ensure true trauma-informed care when working with BIPOC clients. Implementing the above strategies not only supports clients in exploring identity-based wounds, but also helps them uncover narratives of resilience and strength that can foster positive racial identity socialization. When clinicians invite this discussion at the onset of treatment, a deeper level of openness and healing becomes possible.

Dr. Jenay Garrett is a Licensed Professional Counselor and EMDRIA Certified Therapist™ with 16+ years of experience. She owns P.E.A.C.E. Clinical Solutions, LLC, offering counseling, consultation, and supervision. Dr. Garrett is also the founder of Swerve the Stigma, empowering Black and Brown communities by challenging mental health stigmas. As an EMDRIA Approved Consultant-in-Training™, she is dedicated to using EMDR to help clients heal and grow.

References and Resources

Archer, J. A. (2020). Decolonizing trauma treatment. Unpublished manuscript.

Ashley, W. & Lipscomb, A. (2020, Fall). Addressing racialized trauma utilizing EMDR and antiracist psychotherapy practices. Go With That Magazine, 22-26. https://www.emdria.org/magazine/addressing-racialized-trauma-utilizing-emdr-and-antiracist-psychotherapy-practices/. Also available open access from EMDRIA Focal Point Blog: https://www.emdria.org/blog/black-history-month/

Bryant-Davis, T., & Ocampo, C. (2005). The trauma of racism: Implications for counseling, research, and education. The Counseling Psychologist, 33(4), 574-578. https://doi.org/10.1177/0011000005276581

Comas-Díaz, L. (2016). Racial trauma recovery: A race-informed therapeutic approach to racial wounds. In T. Bryant-Davis (Ed.), Religion, spirituality and trauma: An African American theological perspective (pp. 249-273). Praeger.

Gomez, A. M. (2020). Playful EMDR: A manual for clinicians who work with children and teens. PESI Publishing.

Mbazzi, F. B., Dewailly, A., Admasu, K., Duagani, Y., Wamala, K., Vera, A., Bwesigye, D., Roth, G. (2021). Cultural adaptations of the standard EMDR protocol in five African countries. Journal of EMDR Practice and Research, 15(1), 29–43. https://doi.org/10.1891/EMDR-D-20-00028

Pieterse, A. L. (2018). Attending to racial trauma in clinical supervision: Enhancing client and supervisee outcomes. Clinical Supervisor, 39(1), 1-17. http://dx.doi.org/10.1080/07325223.2018.1443304

Tervalon, M., & Murray-García, J. (1998). Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education. Journal of Health Care for the Poor and Underserved, 9(2), 117-125. https://doi.org/10.1353/hpu.2010.0233

Williams, M. T., Printz, D., DeLapp, C., & DeVeaugh-Geiss, J. (2018). Assessing racial trauma within a DSM-5 framework: The UConn Racial/Ethnic Stress & Trauma Survey. Practice Innovations, 3(4), 242–257. https://doi.org/10.1037/pri0000076

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Using EMDR with BIPOC Clients: Six Strategies for Children, Adolescents, and Adults