EMDR Informed Consent Eye Movement Desensitization & Reprocessing (EMDR) is a form of therapy that utilizes bilateral stimulation (BLS) usually in the form of eye movements, tapping or auditory tones in order to accelerate the brain’s capacity to process and heal a troubling memory, thought, feeling, or phobia. BLS stimulates the same eye movements which occur during Rapid Eye Movement (REM) or dream sleep. BLS causes two parts of the brain to work in conjunction in order to reintegrate a memory. Some clients can experience relief or positive effects in just a few sessions and others need more sessions. EMDR is effective in treating trauma-related symptoms, whether the traumatic event occurred many years ago or yesterday. Research has demonstrated that EMDR is effective for the treatment of Post Traumatic Stress, phobias, panic attacks, anxiety disorders, stress, sexual and physical abuse, disturbing memories, complicated grief and chronic pain.

The possible benefits of EMDR treatment include the following:

The memory or event is remembered, but the painful emotions and physical sensations, disturbing images and thoughts are no longer present.

EMDR helps the brain reintegrate the memory or event and store it in a more appropriate place in the brain. The client’s own brain reintegrates the memory or event and does the healing. The possible risks of EMDR treatment include the following: Reprocessing a memory or event may bring up associated memories. This is normal and those memories will also be reprocessed. During the EMDR, you may experience physical sensations and retrieve images, emotions, and sounds associated with the memory or event. Reprocessing of the memory or event normally continues after the end of the formal therapy session. Other memories, flashbacks, feelings, and sensations may occur. You may have dreams associated with the memory. Frequently the brain is able to process these additional memories without help, but arrangements for assistance will be made in a timely manner if the client is unable to cope.

As with any other therapeutic approach, reprocessing traumatic memories can be uncomfortable; that means some people won’t like or won’t be able to tolerate EMDR treatment well. Others may need more preparation, offered by the therapist, before processing traumatic events using EMDR. There is no known adverse effect for interrupting EMDR therapy; therefore, you can discontinue treatment at any time. Alternative therapeutic approaches may include individual or group therapy, medication, or a different psychotherapy modality on an individual basis.

The client must be able to tolerate high levels of emotional disturbance, have the ability to reprocess associated memories resulting from EMDR therapy, and to use self-control and relaxation techniques such as calm place, container. Disclose to me and consult with your physician before EMDR therapy if you have a history of current eye problems, a diagnosed heart disease, elevated blood pressure, or are at risk for or have a history of stroke, heart attack, seizure or other limiting medical conditions that may put you at medical risk. Pregnant women should consult with their physician. Due to the stress related to reprocessing some traumatic events, postponing may be appropriate in some cases. 3. Inform me if you wear contact lenses and remove them of they impede eye movements due to irritation or eye dryness. I will discontinue BLS if you report eye pain and other forms of stimulation can be substituted, if appropriate. Before participating in EMDR, discuss with me all aspects of an upcoming legal court case where testimony is required. You may need to postpone EMDR treatment is you are the victim or witness to a crime that is being prosecuted because the traumatic material processed using EMDR may fade, blur or disappear and your testimony may be challenged.

Consult with your medical doctor before utilizing medication. Some medications may reduce the effectiveness of EMDR, for example, benzodiazepines may reduce effectiveness.

Discuss with me any dissociative disorders with little treatment progress. EMDR may trigger these symptoms, but may also be helpful in attempting to resolve them.

I HAVE READ AND UNDERSTAND THE POSSIBLE OUTCOMES OF EMDR LISTED ABOVE AND UNDERSTAND THAT I CAN END EMDR THERAPY AT ANYTIME. I AGREE TO PARTICIPATED IN EMDR THERAPY AND I ASSUME ANY RISKS INVOLVED IN SUCH PARTICIPATION.

Name (printed) _____________________________________________________________ Signature ___________________________________________

Date __________________ Signature of Witness _________________________________________________________