What to do If a client scores high on the DES

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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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Dr. Amber Quaranta-Leech, LPC-S

Amber holds a PhD in Counselor Education and Supervision from Regent University. She is a Licensed Professional Counselor in both Texas and Oklahoma and holds Supervisor credential for Texas. Amber is an EMDRIA consultant and trainer. She has over a decade of experience in the trauma field in work with uniformed services, domestic violence, childhood trauma and abuse, and recent mass trauma events. Amber provides consultation for EMDRIA certification, for consultants-in-training, and supervision for LPC-Associates. Amber continues to research the benefits of EMDR therapy with a variety of populations. Her goal is to help build strong clinicians who are well versed in trauma interventions to better support their clients. Amber sees a limited number of clients with a focus on trauma work, she is also a Certified Career Counselor and Certified through EAGALA to provide equine-assisted therapy. 

Dr. Jose Carbajal, LCSW

Dr. Jose Carbajal, a U.S. Army veteran, earned his bachelor’s and master’s degrees in social work and a master’s in theological studies from Baylor University, and a Ph.D. in Social Work from the University of Texas at Arlington. With over 15 years of clinical experience and extensive teaching experience, Jose specializes in trauma, sexual abuse recovery, domestic violence, and substance abuse. His research focuses on trauma interventions, neuroscience, and faith. He is EMDR Certified, an Approved Consultant, and an EMDRIA Approved Trainer, with numerous publications and professional presentations to his name.

Dr. Amanda Martin, LMFT-S, LPC, BCN

Amanda Martin holds a PhD in Family Therapy and is a Licensed Professional Counselor, Licensed Marriage and Family Therapist Supervisor, and EMDRIA Approved Consultant. With over 14 years of experience, she specializes in trauma therapy for individuals and families in residential and outpatient settings. Amanda also provides supervision for EMDR certification, EMDR consultants-in-training, and LMFT-Associates. Her mission is to help people find a healthy, joyful, and fulfilling path in life. Her warm, supportive, and interactive counseling style incorporates Symbolic Experiential Therapy, Trauma-Focused Cognitive Behavioral Therapy, EMDR, HeartMath, Animal-Assisted Therapy, Neurofeedback, and Collaborative Problem Solving.

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