Defining New Credentialing Standards: An Update on the Work of the EMDRIA Professional Development Subcommittee
Presented: September 2013
Wendy J. Freitag, PhD, Chair; Jocelyn Barrett, MSW, LICSW, Co-Chair, Standards & Training Committee; Nancy Errebo, PsyD; Regina Morrow, Ed.S, LMFT, LMHC
Abstract:
This document presents the efforts, to date, of The Professional Development Subcommittee to define standards for EMDR International Association (EMDRIA) credentialing, as charged by the EMDRIA Standards and Training Committee. The development of defining the standards at each credential level (Certification, Approved Consultant, and Approved Trainer) requires a multi-stage approach. This document, which reflects the first stage in the development process, identifies and delineates the Core and Essential Competencies for EMDRIA Certification in EMDR. This document will undergo review and public comment; therefore, what is presented here is subject to revision. Further, this document does not represent the policy of EMDRIA.
Building on Freitag’s (2012) foundation, the subcommittee proposes that a competency-based system of credentialing replace EMDRIA’s current hours-based requirement system. Competency-based training and practice of psychotherapy has emerged as a significant movement among five mental health disciplines---psychiatry, psychology, marital and family therapy, counseling, and social work----in response to the Institute of Medicine’s (2003) recommendation that mental health disciplines define a set of core competencies for clinical practice (Freitag, 2012; Sperry, 2010).
Sperry’s (2010) Core Competency Model was chosen as the template for the subcommittee’s work because, like EMDR, Sperry’s model is integrative. Sperry’s model identifies six core competencies espoused by all five mental health disciplines, shows how these core competencies are inter-related, and describes the application of these core competencies in Dynamic, Cognitive-Behavioral, and Systemic psychotherapies.
Sperry’s Six Core Competencies of Effective Psychotherapists are:
1) Conceptual Foundation
2) Relationship Building and Maintenance
3) Intervention Planning
4) Intervention Implementation
5) Intervention Evaluation and Termination
6) Culturally and Ethically Sensitive Practice
In the current document, each of Sperry’s Six Core Competencies as well as the Essential Competencies within each Core Competency will be delineated, first, as defined by Sperry for clinicians of all approaches, and second, as particular to EMDR as defined by EMDRIA (2012).
Core and Essential Competencies for EMDRIA Certification in EMDR
I. Conceptual Foundation
The theoretical framework is one requisite clinical competency to which all other clinical competencies are anchored. “First therapists need a theoretical understanding of the normal process of development and functioning, which can be called the theory of personality. Second therapists need a theory of how functioning goes awry and becomes maladaptive, which is a theory of psychopathology. Third, therapists need a theory of how maladaptive processes can be changed, that is, a theory of therapeutic processes” (Sperry, 2010, p. 21).
Conceptual Foundations of the EMDR Approach to Psychotherapy
The EMDRIA Certified Clinician (ECC) demonstrates understanding of the Adaptive Information Processing (AIP) model that is the basis of the EMDR Approach to psychotherapy and the application of AIP in EMDR protocols. The ECC is able to clearly and succinctly define EMDR, articulate AIP principles to clients, colleagues, and the public, and describe the Eight Phases of EMDR and the Three-Pronged Protocol. The ECC demonstrates the capacity to use AIP to implement EMDR effectively and consistently with clients with conditions with which they have expertise (EMDRIA, 2012).
The ECC demonstrates the capacity to understand, articulate, elucidate and apply the following fundamental principles of the EMDR Approach as defined by EMDRIA:
1) EMDR is an approach to psychotherapy, not a technique (EMDRIA, 2012).
2) EMDR is an integrative psychotherapy approach that evolved primarily from clinical experience. Integrative has several meanings (International Integrative Psychotherapy Association, 2013).
a) It draws from many views of human functioning: client centered, behavioral, psychodynamic, cognitive, body-focused, Gestalt, and cognitive neuroscience (Norcross & Shapiro, 2002; Shapiro, 2001, 2002a).
b) It is intended to integrate the personality, bringing unassimilated negative information together with positive resources to empower a whole human capable of love and service (EMDRIA, 2012; Shapiro, 2002a; Siegel, 2002).
c) It is intended to bring together the affective, cognitive, behavioral, physiological, and spiritual systems of a person to facilitate healing of psychological disorders (EMDRIA, 2012; Krystal, et al., 2002; van der Kolk, 2002).
3) EMDR is based on the Adaptive Information Processing (AIP) model. The principles of AIP are as follows (EMDRIA, 2012; Shapiro, 2001)
a) Every individual has an inherent information processing system that naturally reorganizes disturbing life events to an adaptive resolution.
b) This information processing system is sometimes disrupted resulting in the memory of a disturbing life event being stored in state specific form.
c) EMDR protocols, combined with Bilateral Stimulation (BLS), activate the inherent information processing system and keep it active until an adaptive resolution is achieved. The concept of self-healing is central to this principle.
d) EMDR reprocessing facilitates associations within and among memory networks, ultimately achieving the integration of the disturbing memory with the individual’s resources.
4) EMDR has Eight Phases, each with its own purpose and tasks (EMDRIA, 2012; Shapiro, 2001).
5) In the Three-Pronged Protocol, EMDR addresses past experiences that have set pathological trajectories, present stimuli that trigger problem emotions, body sensations, thoughts, and behaviors, and templates for desired future behaviors (EMDRIA, 2012; Shapiro, 2001).
6) EMDR occurs in the context of an empathic, collaborative therapeutic relationship (EMDRIA, 2012; Shapiro, 2001).
7) EMDR protocols and procedures are embedded in a comprehensive treatment plan guided by the client’s goals and the clinician’s expertise (EMDRIA, 2012; Shapiro, 2001).
Theory of Personality:
The ECC demonstrates the capacity to understand, articulate and elucidate a theory of personality based on the AIP model (EMDRIA, 2012).
The AIP model regards the personality as a constellation of characteristic patterns and responses, each of which is considered an interaction of genetic factors and experiences. The basis of personality development is regarded as the assimilation of experiences into the associative memory networks and accommodation of each experience into the person’s self-identity (Shapiro, 2001, 2002a).
Theory of Psychopathology:
The ECC demonstrates the capacity to understand, articulate, and elucidate a theory of psychopathology based on the Adaptive Information Processing (AIP) model.
The Adaptive Information Processing (AIP) model posits that disturbing information stored in the nervous system is the basis of psychopathology (EMDRIA, 2012; Shapiro, 2001). Singular traumatic experiences appear to disrupt the information processing system, resulting in disturbing information being stored in state specific form in an isolated memory network. Chronic adverse experiences appear to decrease flexibility in the information processing system, favoring one maladaptive way to process information (Leeds, 2009). New learning cannot link with this dysfunctionally stored information because of the intense affect generated whenever the disturbing memory is stimulated by present events. When the disturbing information is stimulated, the individual feels, thinks, and behaves in a manner similar to how he or she did at the time of the disturbing event (EMDRIA, 2012; Leeds, 2009; Shapiro, 2001, 2002a).
Theory of Psychotherapeutic Process:
EMDR is an integrative psychotherapy with principles, procedures, and protocols that are embedded in a comprehensive treatment plan. EMDR Treatment proceeds in eight distinct phases. EMDR addresses past experiences, current challenges, and desired future behaviors. In the reprocessing phase of treatment, Bilateral Stimulation (BLS) is employed to stimulate the inherent information processing system in its work of transmuting disturbing memories to an adaptive resolution. The client’s own brain is doing the healing, so the clinician is a guide, rather than a director, of the process. Thus, during this phase, the clinician refrains from offering interpretations or engaging in dialogue. As long as spontaneous reprocessing, indicated by shifts in affect and cognition, is taking place, the clinician gives minimal input. If reprocessing stalls, the clinician applies brief interventions to resume effective reprocessing. Phase Eight, Reevaluation, guides ongoing work towards the treatment goals and maintains client stability (EMDRIA, 2012; Leeds, 2009; Shapiro, 2001).
The ECC demonstrates capacity to describe, elucidate, and apply the following:
1) Identify the Eight Phases of the standard EMDR protocol. Delineate the specific purposes, goals, and tasks of each phase.
2) Develop a comprehensive treatment plan in Phase One that is individualized to the client’s goals and resources.
3) Prepare client for safe, effective EMDR reprocessing of disturbing life events in Phase Two.
4) Apply Phases Three through Seven to reprocess past experiences, current triggers, and future templates.
5) Recognize ineffective reprocessing and implement brief interventions to stimulate the AIP and resume effective reprocessing in Phases Four and Five.
6) Utilize Phase Eight to guide ongoing treatment.
II. Relationship Building and Maintenance
Competent therapy depends on the establishment and maintenance of an effective therapeutic alliance. The therapeutic alliance fosters a bond of trust between client and therapist and a mutual agreement about goals and methods of the treatment process. This Core Competency consists of five Essential Competencies (Sperry, 2010):
1. Establish An Effective Therapeutic Alliance
2. Assess Readiness and Foster Treatment Promoting Factors
3. Recognize and Resolve Resistance and Ambivalence
4. Recognize Therapeutic Alliance Rupture
5. Recognize and Resolve Transference-Countertransference Enactment
II. 1. Establish An Effective Therapeutic Alliance
“This competency involves the capacity to form an effective therapeutic alliance that is sensitive to the client’s needs, expectations, and explanatory model; that engenders trust and hope in the therapist and therapy process; and that engages the client in the treatment process” (Sperry, 2010, p. 44).
The integrative view operationalizes the therapeutic alliance in terms of three interdependent variables: 1) agreement on therapeutic tasks, 2) agreement on therapeutic goals, and 3) the quality of the interpersonal bond between therapist and client (Sperry, 2010).
EMDR Approach to Establishing an Effective Therapeutic Alliance
The ECC demonstrates capacity to achieve a therapeutic alliance during Phases One and Two that supports the reprocessing of disturbing life events in Phases Three through Seven (Leeds, 2009; Shapiro, 2001, 2005).
The ECC demonstrates capacity to describe the elements of establishing the therapeutic alliance that are particular to EMDR:
1) The ECC helps the client develop trust not only in the clinician but also in the principle of self-healing and the AIP model.
2) The ECC helps the client develop the capacity and skill to make the honest, accurate self-report of internal, private experience that is necessary to maintain client stability and guide reprocessing and ongoing treatment.
3) The ECC recognizes and articulates potential difficulties in EMDR treatment that may arise from assumptions about the therapeutic alliance that are perceived to conflict with EMDR procedures. The ECC reconciles those conflicts and integrates EMDR and AIP into his or her preferred approach to establishing the therapeutic alliance in a way that maintains fidelity to EMDR procedures (Adler-Tapia & Settle, 2008; Korn, Zangwill, Lipke, & Smyth, 2001; Leeds, 2009).
The ECC collaborates with the client to set treatment goals and tasks that take into account the clients expectations and wants as well as the clinician’s expertise.
II. 2. Assess Readiness and Foster Treatment Promoting Factors
“This competency involves the capacity to accurately identify the client’s motivation and readiness for change as well as to effectively foster treatment factors that will promote and facilitate the treatment process” (Sperry, 2010, p. 44).
EMDR Approach to Readiness and Fostering Treatment Promoting Factors
The AIP model posits that current problems are rooted in past disturbing life experiences. Reprocessing those negative experiences, using the Three-Pronged Protocol, in Phases Three through Seven, results in positive changes in feelings, thoughts, and behavior that occur naturally, organically, and without conscious effort (EMDRIA, 2012; Shapiro, 2001).
The ECC articulates, elucidates, and applies elements of motivation and readiness that are particular to EMDR:
1) Readiness for reprocessing of disturbing life experiences in Phases Three through Seven comprises the following: (Leeds, 2009; Shapiro, 2001)
a) Affect tolerance
b) Ability to shift from a negative emotional state to a neutral or positive emotional state
c) Adequate physical, social, financial, and emotional resources to sustain ongoing treatment
d) Ability to devote adequate time and attention to the treatment without undue interference from other commitments on the part of both client and clinician
e) The ECC is proficient in assessing readiness for reprocessing and in interventions that remediate deficiencies and promote readiness.
2) Motivation to proceed with reprocessing may be reduced by fear and/or secondary gain issues. The ECC is proficient in resolving those issues so that the client is able to reprocess disturbing life experiences.
II. 3. Recognize and Resolve Resistance and Ambivalence
“This competency involves the capacity to accurately identify indicators of client resistance and/or ambivalence in a clinical context as well as to effectively resolve the resistance or ambivalence, which results in maintaining and enhancing the therapeutic relationship” (Sperry, 2010, p. 64).
From the integrative perspective of the Core Competency Model, resistance or noncompliance is understood as ambivalence, which is usually manifested as defensive avoidance or a repetitive pattern of negative interpersonal behaviors. When this happens in the therapeutic setting, the therapist must be mindful this is a temporary state rather than a personality trait (Sperry, 2010).
EMDR Approach to Recognize and Resolve Resistance and Ambivalence
The ECC articulates, elucidates, and applies understanding of resistance and ambivalence particular to AIP and EMDR (Leeds, 2009; Shapiro, 2001).
1) AIP views resistance and ambivalence as fears, phobias, or blocking beliefs originating in disturbing life events.
2) The memories of the disturbing events can be targeted and reprocessed, thus organically resolving ambivalence and resistance to ongoing EMDR work.
3) Resistance and ambivalence can appear in any phase of EMDR.
II. 4. Recognize and Resolve Transference-Countertransference Enactment
“This competency involves the capacity to accurately identify indicators of transference and countertransference, including transference enactments, as well as to effectively resolve such enactments, which results in maintaining and enhancing the therapeutic relationship” (Sperry, 2010, p. 64).
Transference is the client’s inaccurate transfer of thoughts, feelings, and expectations about past interpersonal experiences onto the current relationship with the therapist.
Countertransference is the therapist’s inaccurate transfer of thoughts, feelings and expectations from past experiences onto the current relationship with the client (Sperry, 2010).
EMDR Approach to Recognize and Resolve
Transference-Countertransference Enactment
The ECC articulates, elucidates, and applies understanding of transference and countertransference enactment that are particular to EMDR.