EMDR Standard Procedure Worksheet

Instructions:

Let’s create a stop signal. What could that be for you?

“Every so often, I will do a simple check on what you are experiencing. All you need to do is tell me about what you are experiencing so I can make the proper choices. There is no right or wrong way to do EMDR. Sometimes things will change, and sometimes they won’t. Just give me accurate feedback about what is happening and let whatever happens, happen. Also, remember you are the one in control, and if you need to stop, use your stop signal.”

Phase 3: Original Incident - Issue or Memory:

“What incident or memory would you like to work on today?”

Target Image:

“When you think about that memory, what picture or image represents the worst or most

powerful part? What do you visualize?”

Negative Cognition (NC)

“When you think about that memory or image, what negative belief do you have about yourself now?”
(This should be an “I” statement in the present tense. It usually is a presently held negative, self-referencing belief that is

irrational.)

Positive Cognition (PC)

“When you bring up the memory, image, or incident what would you like to believe about yourself now?”
(The PC is a presently desired, self-referencing belief that corresponds with the NC.)

Validity of Cognition (VoC)

“When you think of that memory or image, how true does (repeat the PC) feel to you now on a scale of 1 to 7, where 1 feels completely false and 7 feels completely true?”

(Completely false) 1—-2—-3—-4—-5—-6—-7 (Completely true)