What to do If a client scores high on the DES

The question often comes up what a client scores 30 or over on the DES, what do we do?

The following are some guidelines that are open to discussion and may change over time.

First, recheck your math.  For the adult DES it is  Total Score pided by 28 = X.  If  is  X is lower than 30 then they are cleared for the Standard EMDR Protocol, if X is 30 or more then we change our approach but that doesn’t mean we don’t do EMDR.  (If you don’t know what X is, then that’s why you’re in counseling.)  For the teen DES, it is the total score pided by 30, and the mean number is 3, not 30.  But the same guidelines apply, using 3 instead of 30.

Be sure to note is that the DES score is a guideline indicator not an absolute.  That is, someone may score 25 or more and you’ll want to go slower, or they may score over 30 and you can proceed but with caution.

When they score high on the DES, we go over the inventory with them and pay attention to the the questions that were scored highest on.  We go over those questions with the client, asking things like, “Do you know that when happens?”  “Do you know what triggers it?”  Some answers you can normalize, like highway spacing out, and some you may not.  That can become part of the therapy over the next few weeks, asking if they noticed if and when they dissociated, what was the effect, and what they did or didn’t do about it.

We also do more phase 2, which is resourcing (RDI), grounding, containers, and Safe place.

So there is still EMDR to do, we just go slower and shift focus to phase 2.

They can retake it in 30 days or so to see if it changes.  If the score lowers then maybe do EMDR processing, if not, then more training for the therapist in working with dissociative clients might be in order.

Your comments and observations are welcome.

Thanks,  Jordan

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