The 12 Gifts of EMDR Efficacy

By Susie Morgan, LMFT, BCETS - December 16, 2025

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EMDR Tips to Help You Think Critically, Adapt Skillfully, and Treat Trauma More Effectively

12 bits of practical guidance for providing EMDR with clarity, flexibility, and personalized effectiveness.

As the year winds down—or perhaps winds up, depending on when you’re reading this—I wanted to offer a gift. Actually, twelve gifts.

Whether you’re catching this in December or June, whatever holidays you may celebrate, this is for you: 12 tips to help make your EMDR therapy more effective, more attuned, and more transformative.

While recently updating our Basic Training webpage, I was listing how we do things differently at Precision EMDR (on purpose). Because frankly, the way EMDR has traditionally been taught doesn’t always translate into proficiency in treating trauma.

I started thinking about our value system—to teach Shapiro’s original model in a way that helps clinicians integrate what truly makes EMDR effective.

Not technically rigid. Not “correct” according to the wording on the scripts. But actually proficient at providing EMDR therapy—actually effective in the room with clients, especially those with complex trauma.

Because here’s the thing: EMDR isn’t a religion.

But sometimes in the field, it’s treated like one. Sacred scripts. Dogmatic rules. Fear of deviating from the “manual.” And while the history and the research brought us to where we are today, the truth is—this “high-control religion” approach doesn’t serve our clients.

EMDR is not about doing it by the book for the book’s sake. It’s about clinical efficacy. About being thoughtful. Strategic. Responsive.

At Precision EMDR, we want clinicians leaving our trainings knowing how to THINK in EMDR.  

To know the HOW and the WHY - so the HOW can be personalized to the needs of a client - and the spirit and power of EMDR is not lost in a rigid, overly-simplistic, bullish application of a scripted HOW.

In the spirit of the “12 Days of Christmas,” these are practical, sometimes what could be considered sacrilegious, always thoughtful tips for making your EMDR therapy more effective.

So here they are. My 12 little gifts to you.

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Tip 1: Light It Up

“If I can’t picture the image in my mind’s eye, it’s not clear enough.”

One of the most critical skills in EMDR is activating the memory. I’m forever grateful to my first trainer, Philip Manfield, who emphasized the importance of specificity and immersive activation.

This isn’t about vaguely referencing "that one time." We’re aiming for sensory detail so vivid you (and your client) can see, hear, and feel it.

Even with amalgam memories, specificity still matters. What is the representative image? And is it clear enough that you can see it in your own mind’s eye?

If it’s still fuzzy for you, it’s probably not lit up enough in the client’s nervous system yet.

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Tip 2: Don’t Just Check Boxes—Activate

Assessment isn’t a checklist. It’s ignition.

The TICES process (Target, Image, Cognition, Emotion, Sensation) isn’t just about gathering baseline data. It’s your chance to light the match.

The science of memory reconsolidation has made it clear that activation is critical for effective reprocessing.

Arrange everything—BLS, positioning, even instructions—before you begin. That way, when the client is activated, you can launch into reprocessing without delay.

And here’s the controversial part: sometimes you should skip the summary phrase entirely. That little script transition—“bring up the image, the cognition, the emotion, the body sensation…”—needs to be seen as optional. If your client is already welling up or visibly moved, don’t pull them out of it with a checklist. Just go.

But if they’re not fully activated? Use those prompts to help them deepen into the memory—but with their words, not a set of generic directions.

Don’t make them do the mental gymnastics of asking themselves: What was my image? My cognition? My emotion and sensation?

Instead, read their words back to them.

Make the activation seamless.

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Tip 3: Stop Making BLS Comfortable (but Don’t Just be Trendy Either)

Your client’s preference isn’t the goal—efficacy is.

Too often I hear, “My client prefers tactile, so I just use that.” Nope. That’s not a good enough reason.

It’s also not a good enough reason to scratch the benefit of standard EMDR reprocessing because EMDR 2.0 is the shiny new trend.

Bilateral/Dual Attention Stimulation (BLS/DAS) isn’t a comfort tool. It’s a clinical tool.

If you want rapid desensitization (especially with really horrific material), lean into working memory taxation like in EMDR 2.0.

But if your goal is to facilitate traveling down the channels of a memory network—unlocking deeper associations, linking adaptive material, and optimizing generalization—EMDR 2.0 can truncate what is possible.

You need enough taxation to drive desensitization, but not so much that it disrupts the full reprocessing arc or shuts down associative pathways.

Adjust based on your intention.

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Tip 4: Try the Triangle

Let the body become the tool.

After initially hearing Ad de Jongh speak on the mechanism of taxing working memory and learning EMDR 2.0, I could not bring myself to ask my clients to jump around. (I’m boring that way.) But, I modified my approach.

Historically, I used light-up buzzers for eye movement plus tactile bilateral stimulation when in my office. So, I asked my clients to pinch their fingers (gently) to match the alternating lights and buzzes.  

Immediately, memories began to metabolize more rapidly.

Then, during COVID, I had to adapt for telehealth.

Enter: The Triangle Technique.

I ask clients to rest their hands visibly in the camera frame about a shoulder’s width apart, forming a triangle with their head and hands. They then alternate pinching each hand and move their eyes to match in coordination. It’s simple. It works. And it avoids all the glitchy tech of online BLS.

Even if your client can’t do eye movement, you can still build working memory tasks using patterned pinches. It’s low-fi and high-impact.

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Tip 5: The Apple Trick

If they can picture an apple, they can do eye movement.

Sometimes clients say, “I can’t do that. I’m not good at eye movement.” Before you default to tactile, try this.

Have them do a few sets of eye movements while thinking about an apple. Then ask: What color was it?

If they say, “Red, green, speckled, Gala…”—great. That proves they can track, visualize, and describe. You’ve just shown that their visualization skills are sufficient—and built their confidence at the same time.

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Tip 6: VOCs Don’t Need to Be 1–7

Use zero to ten. It’s easier. It’s fine.

The one-to-seven VOC scale? That’s research-driven. It was created so EMDR could be compared with CBT’s Likert scales.

But in the real world, your clients are what matter. And for many, one-to-seven feels awkward and confusing. Zero to ten just makes sense.

The concept of measuring how valid a cognition feels to them now when thinking of the target memory is already a bit of a mind-twisting pretzel.

But, don’t drop the VOC - it matters!  

Clients are embodied nervous systems and meaning makers. Knowing how far they have come and how far they need to go to transform the distorted meaning of a trauma memory is a critical component of EMDR therapy.

As long as you note the change of the VOC scale in your documentation, allow yourself the flexibility to do what is clinically appropriate. Don’t let dogma override clarity.

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Tip 7: Use Your Client’s Own Words

If a cognition follows the rules and nails the meaning for your client—it’s good enough.

Let your clients speak their truth in their language. If their chosen positive or negative cognition resonates deeply, don't reject it just because it’s not on a standard handout.

As long as it follows the core rules—

• Self-referencing
• Reality-based (for PCs)
• Distorted (for NCs)
• Generalizable

—then it’s acceptable. Don’t force them into a phrase that feels foreign. Use what fits them.

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Tip 8: Shapiro’s Categories of Meaning Aren’t Sacred

Two cognitions in the same “domain of meaning” might mean wildly different things to a client.

Organizing your treatment plan by Shapiro’s original cognitive categories—Responsibility/Defectiveness, Safety/Vulnerability, and Power/Control—might help you feel tidy. But it can miss your client.

Clients don’t think in categories. They feel in meaning. What looks like the same belief on paper could represent two entirely separate memory networks.

For instance, “I’m powerless” and “I’m not in control” may fall under the same label, but your client’s nervous system might experience them as fundamentally different.

Let their nervous system guide you in seeing how memories have clustered—and let that map, not the manual, guide your treatment.

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Tip 9: Use Cognitions in Reevaluation

Sometimes meaning is what reactivates what is left of the target.

Yes, bring up the image. Yes, check the emotions and the body. But sometimes, it’s revisiting the cognition—“I’m worthless” vs. “I’m worthwhile”—that lights up what’s still lingering in the system.

Some clients won’t fully activate what’s left of the trauma node unless you reintroduce that meaning. And if you skip it, you might miss the very piece that still needs to process.

So don’t be afraid to check the VOC again. It’s not a betrayal of the Standard Protocol.

It’s a clinical choice point to honor what matters most—not missing tendrils of unprocessed memory that can leave a client vulnerable to relapse.

Even Francine Shapiro said it can be useful to ask for the VOC during Reevaluation. (It’s buried deep in the book, but it’s there. I promise.)

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Tip 10: Let Them Name More Than One NC

Why wait for blocking beliefs when you can identify the relevant NCs up front?

The lore we’ve been taught is that we must insist clients choose one negative cognition per target memory.

But real memories—especially trauma memories—don’t usually come with just one distorted belief. Forcing clients to narrow it down can actually make the work harder in the long run.

Throughout her text, Shapiro talks about looking out for other cognitions—as potential sources of blocked processing or incomplete resolution.

So why not gather them at the beginning?

Let your client name any negative cognitions they associate with the target memory. Just make sure to gather the corresponding positive cognitions and VOCs.

Because when you get to reevaluation and your client says, “That NC’s resolved, but this one’s still stuck,” you won’t be starting from scratch. You’ll already know what’s left to process.

It’s not about making things more complicated. It’s about doing the work more efficiently—and with more respect for the complexity our clients carry.

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Tip 11: Go Further Than You (and Your Client) Think is Possible

When it feels done—go one more set.

Your client says, “That’s probably as far as this is gonna go.” The SUD is low. The VOC is decent.

Don’t stop.

Go further.

Push. One or two (or six!) more sets. That’s where the magic often happens. That’s where it gets brighter, deeper, embodied.

That’s when you get the goosebumps.

Don’t let logic call it too soon.

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Tip 12: Take Good Notes

Because remembering is part of holding.

Your notes aren’t just for documentation. They’re part of the clinical container.

They allow you to quote the client’s language, track transformation, and follow threads across time. That’s attunement. That’s clinical excellence.

When you remember the image they described, the exact phrase they used, or the somatic cue they named three sessions ago—it tells them: You were there. You still are.

That’s what they need.

You’re holding their story. Honor it.

This might seem obvious, but it’s often overlooked.

When I was the client, my therapist didn’t take notes—“for privacy reasons”—and couldn’t remember what we’d worked on. That was painful. But it also caused us to lose our track of where were were.

Beyond the relational impact, specific notes give you clinical traction.

They help you pick up a thread that might otherwise be lost—so you don’t lose your place or leave a tendril of memory unprocessed.

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Wrap-Up: This Isn’t About Dogma. It’s About Depth.

EMDR is a powerful tool—but only if we use it wisely. Not rigidly. Not religiously. But responsively, strategically, and with clinical attunement.

I hope these twelve tips invite you to think more critically, work more fluidly, and reconnect with the deeper possibilities of this method.

And if you want to go deeper—to learn how to think in EMDR, instead of rigidly follow the steps—join us at Precision EMDR. It’s what we’re all about.

I’d love to hear from you.
Which of these tips resonated? Challenged you? Changed how you think? Leave a comment on the YouTube video or message me on Instagram @precisionemdr.

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Resources to Develop and Deepen Your EMDR Skills:

• Precision EMDR Basic Training: CLICK HERE
• Precision EMDR Refresher Course: CLICK HERE
  
• Advanced Certification in Complex Developmental Trauma: CLICK HERE

References:

Ecker, B., Ticic, R., & Hulley, L. (2023). Unlocking the emotional brain: Eliminating symptoms at their roots using memory reconsolidation (2nd ed.). Routledge. https://doi.org/10.4324/9781003200653.

Matthijssen, S. J. M. A., Brouwers, L., van Beerschoten, M., & de Jongh, A. (2021). EMDR 2.0: An integrative and strategic approach to EMDR therapy. Journal of EMDR Practice and Research, 15(1), 22–35. https://doi.org/10.1891/EMDR-D-20-00035‍