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ForwardStandards of Care and Ethical Challenges for Using EMDR Therapy in the Treatment of Complex Trauma and Dissociation
Abstract
The use of EMDR therapy to treat complex trauma and dissociation has been fraught since early in the existence of the approach. Despite the great emphasis on the practical complexities, there has been, with limited exception, virtually no discussion of the potential and actual ethical and legal ramifications either in contemporary writing or training. Even today, ‘dissociation’ is categorized as a ‘population’ and thus typically treated as an ‘advanced practice’ topic rather than as an issue foundational to all EMDR therapy practice. As a result, most practitioners who complete accredited EMDR therapy basic training are left unprepared to recognize both dissociation in its many forms and that, without additional, extensive training, they are likely not qualified to treat persons with dissociative symptoms/disorders. This often results in clinicians who either “don’t know what they don’t know yet” or believe they know more than they actually do. Both of these scenarios pose a variety of ethical challenges into which EMDR therapists may unwittingly stumble and become entangled, but which are also preventable. This presentation will define and illustrate these challenges, as well as point to potential remedies.
To that end, in the first half of this presentation, we will identify and define concepts integral to the discussion of ethics in the context of EMDR therapy and treatment of dissociation, then highlight the different dimensions and layers of competence and proficiency in EMDR therapy practice. We will begin by reviewing the established standards of care for treating complex trauma and dissociation both more broadly and within an EMDR therapy frame. We will then cross-reference the client safety considerations set forth in the Shapiro EMDR therapy text and guidelines for treating complex trauma and dissociative disorders, respectively.
The second half of the presentation will continue by identifying common threads connecting select professional codes of ethics from different regions of the world with best practices previously discussed. From there, we will offer ‘prototypical’ examples highlighting the risks of both over- and under-compensating for a lack of knowledge, competence, and proficiency in treating dissociation using EMDR therapy methods. We will conclude by distilling the specific clinical-ethical challenges observed in the case vignettes and recommend potential remedies for consideration to enhance EMDR therapy practice, consultation, and training moving forward.
Potential to Distress: No
Target Audience
Intermediate
Advanced
Learning Objectives
At the conclusion of this presentation, participants will be able to:
- Define and describe the terms fidelity, competency, and proficiency as they relate to practice of EMDR therapy
- Explain the difference between a proficiency and a practice specialty
- Name the essential standards of care informing the practice of EMDR therapy to treat complex trauma and dissociation
- Describe at least three important considerations related to treatment boundaries
- Describe and compare four distinct schools of thought in the use of EMDR to treat dissociation
- List at least three possible remedies to ethical challenges faced in the use of EMDR therapy to treat dissociation
Timed Outline
PART I
25 Minutes - Introduction and Establishing Our Frame (25 min)
20 Minutes - Defining and Understanding Basic Concepts (20 min)
20 Minutes - Building Proficiency & Competence in EMDR Therapy (20 min)
10 Minutes - Building toward Specialization in EMDR therapy to Treat Dissociative Disorders (10 min)
15 Minutes - Q&A
30 Minutes - Break
PART II
75 Minutes - From Ethics to Standards of Care
15 Minutes - Q&A
60 Minutes - Meal Break
PART III (90 min)
15 Minutes - Considerations for Practice, Training, and Consultation
60 Minutes - Case Vignettes
15 Minutes - Q&A
30 Minutes - Break
PART IV (90 min)
30 Minutes - Case Vignettes (continued)
20 Minutes - Implications for Practice, Training, and Consultation
25 Minutes - Looking to the Future
15 Minutes - Q&A
Jennifer Madere, LPC-S, EMDRIA-Approved Consultant & Trainer
Jennifer Madere is a LPC-Supervisor, EMDRIA Approved Consultant/Approved Trainer in private practice. She is a founding partner of Intuitus Group in Cedar Park, Texas. She has accompanied child and adult survivors of trauma on their journey of healing and recovery in psychotherapy since 2003.
Jennifer has a passion for supervising graduate and post-graduate clinicians and consults and offers training and consultation related to treatment of complex trauma, pathological dissociation, and EMDR therapy. Jennifer is a Fellow of the International Society for the Study of Trauma and Dissociation (ISSTD), co-chair of the ISSTD EMDR Therapy Training Committee, and co-teaches the EMDR therapy training offered by ISSTD. Jennifer also trains fellow clinicians in the ethical integration of faith and spirituality in clinical practice.
In addition to numerous professional presentations in local, national, and international conferences, Jennifer is the published author of several scholarly works on the topics of consultation and screening, assessment, and differential diagnosis for dissociative disorders. She is the primary author for an article focused on best practices in consultation for EMDR advanced designation published in the Journal of EMDR Practice and Research in 2020 and served on a working committee within the EMDR Council of Scholars focused on assessing the teaching and learning of EMDR therapy worldwide from 2021-2023.
Since 2015, Jennifer has collaborated with D. Michael Coy, LICSW, and Paul Dell, PhD to update the interpretive manual and associated documents for the Multidimensional Inventory of Dissociation (MID) and make the MID documents and training accessible to clinicians and researchers world-wide. Michael and Jennifer regularly offer training and consultation to support practitioners in learning to interpret and apply the MID in clinical practice.
D. Michael Coy, MA, LICSW, EMDRIA-Approved Consultant & Trainer
D. Michael Coy, MA, LICSW, (he/they) is a 2006 graduate of The Crown Family School of Social Work, Policy, and Practice at the University of Chicago and currently maintains a private practice in Bremerton, Washington, USA.
Michael is an EMDRIA Approved Consultant and has served EMDRIA in a number of different volunteer capacities over the years. He has presented on EMDR therapy and dissociation for EMDRIA, ISSTD, and independently, and serves as lead trainer for ISSTD’s EMDR therapy basic training, which he helped develop. He co-authored the MID Interpretive Manual, 2nd through 4th Editions, and has updated and managed both the MID Analysis and MID website since 2016. Michael has taught and consulted for hundreds of clinicians, both in the US and internationally, on using the MID for diagnosis, case conceptualization, and treatment.
Michael was co-author of both an article on screening for dissociation in EMDR therapy that appeared in the Journal of EMDR Practice and Research in 2022 and a book chapter on diagnostic instruments for dissociation published in Dissociation and Dissociative Disorders: Past, Present, Future (2nd Edition) in 2022. He is sole author of a chapter on the Autohypnotic Model of Dissociation, which will be part of a forthcoming book on childhood dissociation Michael is currently co-authoring a book on EMDR and dissociation with his frequent collaborator Jennifer Madere. Michael also developed the Introject Decathexis (Id) Protocol, a powerful integrative approach to help unbind perpetrator-identifying states.
Michael was elected to ISSTD’s Board of Directors in 2017, served as Treasurer from 2018 to 2023, and was elected President-Elect for 2024. He was named a Fellow of ISSTD in 2019 and has been honored with a number of awards from the Society, including the Cornelia B. Wilbur Award for Outstanding Clinical Contributions to the Treatment of Dissociative Disorders in 2022.
Available Credit
- 6.00 APAThe International Society for the Study of Trauma and Dissociation is approved by the American Psychological Association to sponsor continuing education for psychologists. The International Society for the Study of Trauma and Dissociation maintains responsibility for this program and its content.
- 6.00 ASWB ACEThe International Society for the Study of Trauma and Dissociation (ISSTD), #1744, is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved as ACE providers. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. ISSTD maintains responsibility for this course. ACE provider approval period: 08/20/2021 – 08/20/2024. Social workers completing this course receive 6.00 continuing education credits.
- 6.00 EMDRIAThe International Society for the Study of Trauma and Dissociation is an EC Provider (#21008) and this program #21008-15 is approved for 6.00 EMDRIA Credits. Eligibility for EMDRIA Credits is restricted to those who have completed an EMDRIA Approved Basic EMDR Training
- 6.00 ISSTD Certificate ProgramThis program is eligible for 6.00 credits in the ISSTD Certificate Program.