D & JAM Trainings

The use of EMDR therapy to treat complex trauma and dissociation has been fraught since early in the existence of the approach (Leeds et al., 2022; Shapiro, 2018). 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’ (e.g., Shapiro, 2018, pp. 342-344; EMDR International Association, 2022) and thus typically treated as an ‘advanced practice’ topic rather than as an issue foundational to all EMDR therapy practice (Shapiro, 2018, pp. 95-96 and Appendix E; International Society for the Study of Trauma and Dissociation, 2011). 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 (2018) 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.