Can I Do EMDR with a Client that Has Recently Self Harmed?

Post by Amanda Martin PhD, LMFT-S, LPC

“Can I do EMDR with a client that has self-harmed recently?” This is a common question in training and the key is the clinical assessment. When assessing if a client with self-harming behaviors is appropriate and ready to start EMDR, I recommend considering the following:

• Is the client motivated and willing to do EMDR? It’s important for the client to have voice and choice in treatment.
• How serious is the self-harming behavior (requires emergency medical attention or superficial)?
• How frequent is self-harm? Are they able to go extended periods of time without self-harm (2 weeks or more)?
• Is the client able to identify the triggers for the self-harm behaviors?
• Does the client respond well to the state change exercises and other self-regulation tools? Are they able to use them when triggered to provide some self-soothing?

If the client is motivated to do EMDR, the self-harm is not life threatening or requires medical attention, is able to identify the triggers for self-harm behavior, and is able to implement state change exercises or self-regulation tools to assist with self-soothing; then I proceed with EMDR treatment. I do spend some time (several sessions) on preparation practicing state change exercises; and create a self-care plan that includes aspects of daily self-care and psychological first aid to use when triggered. If the client is able to progress with these interventions and improve self-awareness to implement the psychological first aid with self-regulation tools outside of session (abstain from self-harm for 2 weeks or more); then I proceed to EMDR phase 3-8 processing the identified targets. It’s important to continue to check in on how the client is doing with the processing and if regression occurs, we return to preparation to stabilize before returning to processing.